BMC primary care最新文献

{"title":"Evaluation of the effectiveness and cost-effectiveness of the chronic disease co-care (CDCC) Pilot Scheme: a study protocol.","authors":"Ivy L Mak, Kiki S N Liu, Zoey C T Wong, Vivian Y H Xu, Esther Y T Yu, Tony K H Ha, William C W Wong, Emily T Y Tse, Linda Chan, Amy P P Ng, Edmond P H Choi, Martin Roland, David Bishai, Cindy L K Lam, Eric Y F Wan","doi":"10.1186/s12875-025-02765-6","DOIUrl":"10.1186/s12875-025-02765-6","url":null,"abstract":"<p><strong>Background: </strong>The Chronic Disease Co-Care (CDCC) Pilot Scheme is a government-subsidized program that aims to provide targeted copayment for the screening and management of hypertension, diabetes mellitus and pre-diabetes in the private healthcare sector. Studies have found that concurrent screening and management with a multi-disciplinary intervention is cost-saving because of the reduction in the rates of premature mortality, complications and utilization of public health services. This study aims to evaluate the quality of care, acceptability, effectiveness and cost-effectiveness of the CDCC Pilot Scheme.</p><p><strong>Methods: </strong>Quality of care will be evaluated by the standards achieved by the program in each criterion in the domains of structure, process and outcomes of care. Site visits and two serial questionnaire surveys at 6 and 12 months will be conducted for the structure of care. Operational data, including the provision of diagnosis and treatment, as well as participants' health status will be extracted to evaluate the process and outcomes of care. Participants' acceptability will be evaluated on experience (accessibility, facility, continuity of care and communication), satisfaction (perceived usefulness, continuation and recommendation) and enablement in 548 CDCC participants at 3 and 12 months by telephone surveys. Evaluation of the effectiveness and cost-effectiveness is a 1-year comparative cohort study using longitudinal data on changes in disease control parameters between CDCC and non-CDCC participants at baseline and 12 months. Costing questionnaires on the set-up and operation costs of the Scheme among service providers, and direct medical costs incurred from public and private service utilization among participants within 12 months from enrolment will be assessed. The incremental costs incurred for an additional participant in the CDCC Pilot Scheme to achieve target disease control outcomes after 12 months will be reported as an indicator for cost-effectiveness.</p><p><strong>Discussion: </strong>The quality of care and effectiveness of the CDCC Pilot Scheme in enhancing the health outcomes of the Scheme participants will be examined. Standards of good practice and recommendations for quality enhancement will be established to inform service planning in similar cross-sector screening and management programme.</p><p><strong>Trial registration: </strong>NCT06310148; 2024-03-22.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of attachment to primary care and unattachment duration on healthcare utilization and cost in Ontario, Canada: a population-based retrospective cohort study using health administrative data.","authors":"Jonathan Fitzsimon, Shawna Cronin, Anastasia Gayowsky, Antoine St-Amant, Lise M Bjerre","doi":"10.1186/s12875-025-02771-8","DOIUrl":"10.1186/s12875-025-02771-8","url":null,"abstract":"<p><strong>Background: </strong>Insufficient access to primary care remains a major public health issue in Ontario, Canada, particularly for unattached residents (i.e., those who are not formally enrolled with a primary care provider, usually a family physician or occasionally a nurse practitioner). This study evaluates healthcare utilization and costs among unattached individuals, focusing on the impact of unattachment duration.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study using health administrative data, comparing provincially insured residents who maintained a consistent attachment status over the 12-month period (April 1, 2021, to March 31, 2022) to those who were unattached. We employed multivariable regression analyses to examine the associations between attachment status, duration of unattachment, demographic and patient health characteristics, and healthcare utilization and costs.</p><p><strong>Results: </strong>Prolonged periods of unattachment to primary care were significantly associated with increased healthcare costs, particularly in populations with a higher burden of comorbidities. In the context of healthcare costs, attached residents with low comorbidities had a median cost of $287, increasing to $3,711 (cost ratio: 12.93, CI: 12.86-13.01, p < 0.0001) for those with high comorbidities. Unattached individuals with low comorbidities had a median cost of $238 (cost ratio: 0.83, CI: 0.82-0.83, p < 0.0001), rising to $7,106 (cost ratio: 24.76, CI: 24.27-25.26, p < 0.0001) for high comorbidities, and up to $8,177 (cost ratio: 28.49, CI: 26.61-30.49, p < 0.0001) for long-term unattached with high comorbidities.</p><p><strong>Conclusions: </strong>Our findings underscore the substantial impact of long-term unattachment on both individual patients and the healthcare system, with higher levels of chronic disease further exacerbating these effects. These results are crucial for shaping programs and policies to maximize their impact on reducing emergency department visits, hospitalizations, and overall healthcare costs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"72"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of patient-reported outcome measures (PROMs) in primary care-based mental health programming: an environmental scan of Alberta, Canada.","authors":"Oacia Fair, Al-Bakir Ali, Michel Haener, Kara Plotnikoff, Nolan Schaaf, Margo Schmitt-Boshnick, Allison Soprovich","doi":"10.1186/s12875-025-02766-5","DOIUrl":"10.1186/s12875-025-02766-5","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"71"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and practices of regional and rural general practitioners in the identification and management of intimate partner and family violence: a mixed methods study in Western Australia.","authors":"Caroline Crossley, Heath Greville, Daniel Pelkowitz, Amanda Gee, Lindi Pelkowitz, Sandra C Thompson","doi":"10.1186/s12875-025-02754-9","DOIUrl":"10.1186/s12875-025-02754-9","url":null,"abstract":"<p><strong>Background: </strong>General Practitioners (GPs) are well placed to identify and assist patients experiencing intimate partner violence (IPV) and family violence (FV). However, patients experiencing IPV/FV can be under-detected or inadequately assisted when GPs do not have the necessary confidence, knowledge, attitudes or skills for this. Given the high rates of IPV/FV in the Australian regional setting where this study was conducted, this investigation explored the confidence, knowledge, attitudes and practices of local GPs in identifying and managing patients who are experiencing IPV/FV.</p><p><strong>Methods: </strong>This mixed methods study utilised a survey tool adapted from a review of existing instruments. The adapted tool included questions on provider confidence, knowledge, attitudes and practices for quantitative analysis, as well as open-response questions that were analysed thematically. All GPs (n = 58) working within the area at the time of the study were invited to participate via emails and written letters distributed through practices and at pre-existing meetings, with 25 completing the survey (43% response rate).</p><p><strong>Results: </strong>Participants lacked knowledge around GP-facilitated disclosure of abuse, many believing the patient to be the main reason for non-disclosure. Half or fewer respondents indicated confidence in creating safety plans with patients, in making appropriate referrals and in identifying IPV/FV by history, signs and symptoms. There were mostly favourable attitudes towards asking about and assisting with IPV/FV, although only one quarter of respondents believed that individuals experiencing IPV/FV can make appropriate choices about how to handle their situation. In terms of practice, only one third agreed that they could match interventions to patient readiness to change. Other key concerns included difficulties in accessing timely support, with improved coordination of local services and systematic changes in the GP environment being the most common recommendations made by respondents.</p><p><strong>Conclusions: </strong>This study demonstrated that the responding GPs in a regional area with high rates of IPV/FV have generally favourable attitudes towards identifying and assisting with IPV/FV but lack knowledge and confidence in the practical elements of enquiry. Surprisingly for a regional area, there was poor understanding of local support provision. The findings have the potential to meaningfully inform regional and rural primary care experiences, including desired educational opportunities and enhancing the relationship between health professionals and relevant community organisations. The results support the need for upstream changes in the general practice environment to improve the ability of regional and rural GPs to build relationships with patients over time and enhance overall health outcomes for those affected by abuse.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"70"},"PeriodicalIF":2.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of non-communicable disease and the associated factors among healthcare workers in Qatar.","authors":"Ayman Al-Dahshan, Noora Alkaabi, Sarah Naja, Nada Adil, Tharaa Al-Shammari, Haya Alkaabi","doi":"10.1186/s12875-025-02760-x","DOIUrl":"10.1186/s12875-025-02760-x","url":null,"abstract":"<p><strong>Background: </strong>Non-communicable diseases (NCDs) significantly impact global health and contribute to economic burdens and premature deaths, with healthcare workers (HCWs) being at high risk. This study aims to assess the prevalence and associated factors of NCDs among newly hired HCWs at Hamad Medical Corporation (HMC) in Qatar.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed 3097 electronic medical records of newly hired HCWs at HMC during 2021 and 2022. Diagnoses were coded using ICD-10 and SNOMED. Descriptive statistics and Chi-square tests were used, with significance set at p < 0.05.</p><p><strong>Results: </strong>The mean age of participants was 31.8 years (SD ± 6.9), with almost equal numbers of males (50.1%) and females (49.9%). Indians made up 36.2%, and 63.9% were married. Professionally, 38% were nurses, 18.8% were physicians, and 11.2% were laboratory professionals. Overall, about one-third (30.9%) of the HCWs had at least one NCD. Diabetes mellitus (11.3%), thyroid disease (9.8%), and hypertension (7.4%) were the most frequent NCDs. Older individuals (≥ 40 years old) have higher comorbidity rates (47%) than younger groups (24%, p < 0.001). Females have higher rates (39.5%) compared to males (22.4%, p < 0.001). Married individuals, nationality, and occupation also significantly influence comorbidity, with administrative staff showing the highest prevalence of NCDs (45.5%, p = 0.011).</p><p><strong>Conclusions: </strong>Over 30% of the newly hired HCWs had an NCD, with diabetes, thyroid disease, and hypertension being most common. Higher prevalence was observed among older staff, females, married individuals, and administrative workers. Targeted workplace health programs are needed for early detection and prevention.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"69"},"PeriodicalIF":2.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An instrument as an action against the blind spot of acute medical care in general practice - a systematic review.","authors":"Johannes Rieken, Daniel Hötker, Christoph Strumann, Jost Steinhäuser","doi":"10.1186/s12875-025-02749-6","DOIUrl":"10.1186/s12875-025-02749-6","url":null,"abstract":"<p><strong>Background: </strong>Increasing visits to out-of-hours practices and Emergency Departments (EDs) for non-life-threatening urgent cases (NLTUCs) have placed a significant burden on healthcare systems worldwide. General practitioners (GPs), as the first point of contact in primary care, play a critical role in managing acute medical cases. However, limited research has focused on their contribution to acute care, and tools for assessing these cases remain non-existent.</p><p><strong>Aim: </strong>This review aimed to identify instruments for detecting acute medical cases in GP practices, addressing the gap in tools and frameworks specific to the primary care setting.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, CINAHL, Scopus, and Web of Science, focusing on studies describing instruments for acute care assessment in primary care.</p><p><strong>Results: </strong>Of 1,560 identified studies, one met the inclusion criteria. The included study described a coding tool designed to assess the complexity of GP consultations, using the ICPC-2 classification system. While this tool effectively captures the multifaceted nature of GP encounters, it was not specifically designed to measure urgency in acute care.</p><p><strong>Discussion: </strong>The review highlights a significant gap in tools for assessing urgency in GP practices, contrasting with established hospital triage systems. Adapting existing tools to incorporate urgency assessment could illuminate the critical impact of GPs on reducing ED burden and managing acute cases.</p><p><strong>Conclusion: </strong>The identified tool for assessing consultation complexity could be adapted to evaluate urgency, highlighting the critical yet underrecognized role of GPs in acute care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"67"},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of implementation of continuous glucose monitoring for patients with Insulin-Treated type 2 diabetes: a national survey of primary care providers.","authors":"Varsha G Vimalananda, Ben Kragen, Alison J Leibowitz, Shirley Qian, Jolie Wormwood, Amy M Linsky, Patricia Underwood, Paul R Conlin, Bo Kim","doi":"10.1186/s12875-025-02764-7","DOIUrl":"10.1186/s12875-025-02764-7","url":null,"abstract":"<p><strong>Objectives: </strong>To identify determinants of continuous glucose monitoring (CGM) implementation from primary care providers' (PCPs') perspectives and examine the associations of these determinants with both PCP intent to discuss CGM with eligible patients and facility-level uptake of CGM.</p><p><strong>Study design: </strong>Cross-sectional survey.</p><p><strong>Methods: </strong>A survey about CGM implementation for patients with type 2 diabetes on insulin was distributed to all PCPs in the Department of Veterans Affairs (VA) health system from October 2023-April 2024. Multi-item scales measured perceived clinical benefits of CGM, workload capacity, knowledge about CGM, access to CGM resources, and support from leadership and other services. Responses were on a 5-point Likert scale from \"Strongly Disagree\" to \"Strongly Agree\". An item asked about likelihood of initiating discussions about starting CGM. Facility-level uptake was measured using VA administrative data. Multivariable regression models assessed the relationship between determinants of CGM implementation and both PCP intent to discuss CGM and facility-level uptake.</p><p><strong>Results: </strong>Of 1373 respondents, most perceived clinical benefits of CGM (79% \"Agree\" + \"Strongly Agree\"). Very few indicated sufficient access to resources (8%) and support from leadership & other services (5%). After adjustment for respondent characteristics, the scale most strongly associated with PCP intent to discuss CGM was PCP Knowledge About CGM (B = 0.54, P <.001). Facility uptake of CGM was associated with Clinical Benefits of CGM (B = 0.10, P =.026) and Support from Leadership & Other Services (B = 0.18, P <.001).</p><p><strong>Conclusions: </strong>PCPs perceive benefits to CGM but lack sufficient knowledge, resources, and workload capacity to manage it alone. PCP education about CGM use and interprofessional support for uptake may increase the likelihood that eligible patients use CGM.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"68"},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways to a diagnosis of trigeminal neuralgia: a qualitative study of patients' experiences.","authors":"Cameron Werner, Jeni Harden, Julia Lawton","doi":"10.1186/s12875-025-02763-8","DOIUrl":"10.1186/s12875-025-02763-8","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal Neuralgia (TN) is a rare disorder which causes episodes of intense facial pain and has been described as the 'suicide disease'. Hence, prompt diagnosis and timely initiation of treatment is vital. However, delays to diagnosis and high rates of misdiagnosis are common, particularly within primary care. To date, most research has focused upon treatment options rather than improving diagnostic experiences. This study sought to explore patients' experiences of the events leading up to their TN diagnosis and their views about the care and support they received when they were diagnosed to provide recommendations for improving the TN diagnostic pathway.</p><p><strong>Methods: </strong>This was a qualitative, exploratory study using in-depth interviews. Interviews were conducted with (n = 25) UK-based people with TN recruited via online forums. Data were analysed thematically.</p><p><strong>Results: </strong>Following the onset of their TN pain, most participants described an arduous and uncertain journey to diagnosis, with many encountering significant delays, misdiagnoses and receiving inappropriate referrals and treatment. As a consequence, participants reported experiencing profound distress, anxiety, depression and, in extreme cases, suicidal ideation; some also described drug and alcohol misuse during this time. Most participants conveyed relief upon finally receiving a diagnosis. However, this was often by eclipsed by what they saw as poor and insensitive communication and inadequate information provisioning.</p><p><strong>Conclusions: </strong>The present study highlights the importance of developing bespoke training for primary care and other professionals to facilitate timely recognition of TN symptomatology and ensure that they deliver a TN diagnosis in clear, sensitive and empathetic ways.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"65"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health nursing consultations in Brazilian primary care: analysis of proposed competencies for advanced practice nurses.","authors":"Patricia Aline de Almeida, Letícia Yamawaka de Almeida, Andrea Liliana Vesga-Varela, Carla Pereira Barreto, Marília Orlandelli Carrer, Keila Gisele Lima Reis, Nayara Vilela de Farias Serranegra, Manoel Vieira de Miranda Neto, Claudia Santos Martiniano, Daiana Bonfim","doi":"10.1186/s12875-025-02761-w","DOIUrl":"10.1186/s12875-025-02761-w","url":null,"abstract":"<p><strong>Background: </strong>Primary Health Care (PHC) is a key strategy to identify, manage, and coordinate mental health cases. Considering that nurses are essential to integrating mental health care into PHC, initiatives to broaden the discussion and incorporate the role of Advanced Practice Nurses in this setting can help reduce disparities in mental health care. Thus, this study aimed to analyze mental health nursing consultations in PHC and investigate whether nurses have the care management skills proposed for Advanced Practice Nurses.</p><p><strong>Methods: </strong>A multicenter study, with a quantitative and qualitative approach, was conducted in 17 Primary Care Health Units distributed in three regions of Brazil from May to July 2022. Data collection was carried out twice during the nurse's professional practice: nursing consultation (recorded using film, with direct and non-participatory observation) and nursing record. From a quantitative perspective and during the first research stage, consultations that had ≥ 50% compliance with the nursing process were selected so that, in the second qualitative stage, the competencies proposed for Advanced Practice Nurses in PHC were identified through content analysis.</p><p><strong>Results: </strong>A total of 49 mental health nursing consultations were performed by 21 nurses. Of these, seven were selected with a score greater than 50% compliance with the nursing process, carried out by three nurses. The consultations presented few competencies in the care management dimension proposed for the Advanced Practice Nurses; nevertheless, nursing consultation presented 39.68% in the care focus, 38.78% in evaluation and diagnosis, and 47.62% in the provision of care.</p><p><strong>Conclusions: </strong>Nurses who conduct mental health nursing consultations in PHC present, in a scarce and partial way, the competencies proposed for the Advanced Practice Nurses for the care management domain. Hence, the results of this study highlight the need for specific training and policy initiatives to enhance the integration of Advanced Practice Nurses in mental health care within PHC, address existing gaps in care management competencies, and improve the quality of mental health services provided to the population.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"66"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of clinical practice guidelines and primary care referral pathways for management of otorhinolaryngological conditions in Pakistan.","authors":"Alina Pervez, Russell Seth Martins, Huzaifa Moiz, Abbas Raza Syed, Muneeb Khan, Nashia Ali Rizvi, Mohsin Ali Mustafa, Muhammad Taha Nasim, Alina Abdul Rehman, Shayan Khalid, Saif Ur Rehman, Sarah Nadeem, Adil H Haider, Shabbir Akhtar","doi":"10.1186/s12875-025-02756-7","DOIUrl":"10.1186/s12875-025-02756-7","url":null,"abstract":"<p><strong>Background: </strong>Diseases of the ear, nose, and throat (ENT) account for a significant portion of a primary care physician's practice in Pakistan, a South Asian lower-middle income country. This increasing burden demands comprehensive clinical practice guidelines and primary care clinical referral algorithms to be devised so that general physicians can adequately provide standardized primary health care and prevent needless specialist ENT referrals.</p><p><strong>Methods: </strong>We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Meniere's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology-Head and Neck Surgery Foundation as the source guidelines and employed the GRADE-ADOLOPMENT approach to contextualize guidelines by adopting, adapting, or excluding recommendations from these guidelines. Clinical referral algorithms were created using recommendations from the created clinical practice guidelines, with additional recommendations being sought via a best evidence review process.</p><p><strong>Results: </strong>We successfully created local clinical practice guidelines for the eight ENT conditions using the GRADE-ADOLOPMENT process. While most recommendations were adopted in the local clinical practice guidelines, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes to provide supporting information. Six recommendations were excluded mostly due to the unavailability of services in Pakistan. Eight clinical referral algorithms were also created which incorporated 17 additional recommendations to fill gaps in clinical practice including four additional recommendations to the epistaxis algorithm, three for neck lumps/mass, rhinosinusitis, and allergic rhinitis, two for acute otitis externa, and one for Meniere's disease and dysphonia algorithms.</p><p><strong>Conclusion: </strong>The newly created clinical practice guidelines will help in the provision of standardized, high-quality care at the primary care level. Concomitantly, the clinical referral pathways can assist the general physicians in the management of patients as well as guide appropriate timely referrals to ENT specialists.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"64"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}